> Some AIDS outreach workers are wary. > > They believe that people who test positive should > hear the news from counselors, who can cushion the > shock, direct them to medical care and explain the > precautions that are needed to avoid infecting > others. > http://www.nytimes.com/2005/11/19/opinion/19sat3.html

They want to control their proprietary positions, theirproprietary jobs. It's like an industry.

Thanks for your suggestion. Getting tested together for before sex isan excellent idea which I often recommend. Had I, rather than theGayHealth.com editor & MD, written the entire first 8 paragraphsmyself, I probably would have included that.(I'd NEVER have used "phenomena" as a singular noun! :-)My message, however, would probably have been justa bit different from yours:

In almost 20 years of HIV/STD education and counseling, I've been led to be much more flexible and pragmatic about people's sexual behavior. One of the toughest lessons that AIDS prevention counselors had to learn, early in the epidemic, is that if the "demands" of safer behavior choices are TOO burdensome or complex (i.e., if the advice is too absolutist), then they are likely to be ignored, pretty completely. (Hence, the accusation of "Sex police!", but that's another discussion...)

Regarding HIV/STD testing before sex,the observed reality-norm is that either(a) it's too late -- sex is already happening; or

(b) the couple is not willing to wait for intimacy.

So........the BACK-UP is to advise condom use for the first 3 months;then test; and if the results are all negative,no symptoms are present, andthe relationship is trusted as monogamous -- OK, dispensewith the condoms IF that's important.(Obviously, needle use changes the equation.)

Granted that condoms are not perfect against all STDs, but they come close enough for most folks, especially horny gay men. Besides, some of the conditions you've listed as "STD" can be transmitted without sexual contact. (I once found 'crabs' crawling around on the weights bench at my recently-gender-integrated gym; and caught scabies from sharing a towel with a university rowing teammate. Molluscum can spread without intimacy, especially among children in daycare to parents, and so can almost anything carried orally, symptomatic or not.)

(2) Gee, you take all the fun out of gettin' hot'n'sweaty with someone by making it sound as if everyone is (at least potentially) crawling with nasty germs.

Of course, I agree cognitively with most of what you say.But, if a reader accepted everything you write, he'd be scared to touch anyone intimately without dressing up like a rubber-clad frogman.(Hmmm, now that presents some interesting images... :-)

The challenge, then, is in making this excellent information user-friendly to the reader, who then is much more likely to incorporate it into his/her decisions and behavior. Life, sex and relationships included, is not without risks -- the key is in(a) learning to manage the risks; and

(b) learning what one is comfortable with and setting behavior limits accordingly.

Appropriate testing is an excellent tool. You touched on communication in relationships, but one thing you overlooked is communication with one's physician -- especially for gay men.The most common reason(s) "not all sites are tested" and"not all STDs are test for" is because(a) the patient was not frank about what he/she had done; and/or

(b) the clinician was ignorant or possibly biased about the stated behavior and its consequences. And unfortunately, given the present political realities in the US, public health clinic resources are so strained that they are NEVER going to do some of the more expensive tests.

Just a couple of errors:1. Yes, there is a test for HPV, even if it isn't "automatically" done; type of HPV is usually included, which is important. (You also list anogenital warts separately -- they are almost always HPV.)

2. At one point, you state that an HIV-ab test is reliable at 3 months; several sections later you say one must wait 6 months. Your first statement was the more correct: by 3 months, accuracy is in the 99% range; like all medical tests, it will never be "perfect".

3. Yes, molluscum can be "tested for", although not in the absence of the symptomatic bumps, from which a sample must be taken. In the absence of symptoms, there's not really a lot of reason to test for it, as it is overwhelmingly (exclusively? -- good research question) transmitted through the bumps. (Since it is a virus, I would expect that some company like Quest or ViroLogic will market an antibody test in time.)

Well, I've blathered on enough. (Feel free to post, with correctattribution, any of the above that's useful.) Thanks for your intelligent,interesting site [ at http://www.seedwiki.com/wiki/not_b4_we_know ] -- keep it up!Sandy

P.S. John James rules! He and Martin Delaney are the most intelligent,informed and insightful writers on HIV in the country!

By John Sandy Bartletthttp://www.gayhealth.com/templates/0/news/index.html?record=1033Even HIV-negative partners in long-term relationships should giveeach other a present by getting tested together to ensure thatthey are both still negative. It is a sad but all too commonphenomena where one partner has sex outside the relationship andbrings HIV back home._______________________________________

One strategy for reducing the risk of getting a sexually transmitteddisease (STD) is for you and a partner to get STD testing (includingtesting for HIV) before having sex.

Getting STD & HIV testing is always a good thing, IF the meaning ofthe test results, and what they imply regarding risks and riskreduction, is understood.

Getting STD & HIV testing before having sex also shows concern foryour own health and the health of your partner, and indicates a desirefor openness and communication, which are good things.

However, it is important to understand that getting STD & HIVtesting before having sex might tell you little about the risks ofgiving something to or getting something from your partner.____________________________________________________________________If testing before sex leads to a false sense of security and sexualpractices that are more risky (for example, not wearing condoms whenyou fuck), then it is a BAD thing.__________________________________

Before discussing getting tested, it is worth visiting the otherstrategy--not getting tested.

For warts, the window period can range up to a year or more, and somepeople with the wart virus do not develop visible warts, though theycan still pass the infection to their partners.

____________________________Tests are not 100% sensitive____________________________

No STD tests are 100% sensitive, that is, none detect the STD 100%of the time.

Amplified DNA tests are in the high 90s, as are a blood test forsyphilis when the person is in the secondary stage and an HIV test 6months or more after exposure to HIV.

Even these tests are not 100% sensitive because of the possibilitiesof errors in collection, labeling, storage, and transport of samples,as well as of laboratory errors.

Other tests fall dramatically in sensitivity, especially ifinfections are recent.

For STDs that can be only be detected visually, the sensitivity of thetest falls to zero percent if no signs of the STD are visible, or ifthe healthcare provider does not look.

For STDs for which there is a test beyond visual examination, STDtests offer a reasonable degree of reliability (perhaps 95 percent)for the things that are tested for 3 months after the most recentexposure (counting sexual contact with any partner).

___________________________________Results Do Not Equal Your Situation___________________________________

There is a difference between knowing the results of a test andknowing your status.

A test can be negative, but that does not mean that you do not havethe STD.

Negative test results only mean that no evidence of the STD inquestion was found.

If your last sexual contact before taking the test was before thewindow period for the test, then the result of the test probablyreflects your situation.

But if you have had more recent sexual contact, then the result of thetest tells you less, and maybe nothing, about your current situation.

Rapid tests versus standard ones are no different with respect tothe information they give you about your status.

_______________Which Partners?_______________

If you are entering a relationship with a primary partner about whomyou are not concerned STD-wise (because you know him, and he knows hisbody, and you are both getting tested), and you are getting testedbecause you are concerned about other contacts, you need to understandthat you can also get STDs from your primary partner and, if he/she isstill in the window period, then the chance of detecting the STDs isreduced.

From the standpoint of STD testing, what determines risk is what youdo with each partner, and what they have done with prior or othercurrent partners.

_____________Communication_____________

Communication in the relationship is probably more important thantesting.

Knowing what infections a person already has, and whether therelationship is open or closed, is important.

Even when getting tests now, you will often have to rely on thehonesty of your partner to give you the results.

Thanks for your suggestion. Getting tested together for before sex is anexcellent idea which I often recommend. Had I, rather than theGayHealth.com editor & MD, written the entire first 8 paragraphs myself, Iprobably would have included that. (I'd NEVER have used "phenomena" as asingular noun! :-) My message, however, would probably have been just abit different from yours:

In almost 20 years of HIV/STD education and counseling, I've been led to bemuch more flexible and pragmatic about people's sexual behavior. One of thetoughest lessons that AIDS prevention counselors had to learn, early in theepidemic, is that if the "demands" of safer behavior choices are TOOburdensome or complex (i.e., if the advice is too absolutist), then theyare likely to be ignored, pretty completely. (Hence,the accusation of "Sex police!", but that's another discussion...)

Regarding HIV/STD testing before sex, the observed reality-norm is thateither(a) it's too late -- sex is already happening; or

(b) the couple is not willing to wait for intimacy.

So........the BACK-UP is to advise condom use for the first 3 months;then test; and if the results are all negative, no symptoms are present,and the relationship is trusted as monogamous -- OK, dispensewith the condoms IF that's important.(Obviously, needle use changes the equation.)

Granted that condoms are not perfect against all STDs, but they come closeenough for most folks, especially horny gay men. Besides, some of theconditions you've listed as "STD" can be transmitted without sexualcontact. (I once found 'crabs' crawling around on the weights bench at myrecently-gender-integrated gym; and caught scabies from sharing a towelwith a university rowing teammate. Molluscum can spread without intimacy,especially among children in daycare to parents, and so can almost anythingcarried orally, symptomatic or not.)

I read your "Draft" of May 13 -- excellent and very thorough discussion.[ at http://notb4weknow.editthispage.com/2005/03/14 ]BTW, your points about STDs frequently being non-symptomatic were excellentand cannot be stressed enough. As a practical matter, however, I have acouple of reservations about tone.(1) See above about why advice is ignored;

(2) Gee, you take all the fun out of gettin' hot'n'sweaty with someone by making it sound as if everyone is (at least potentially) crawling with nasty germs.

Of course, I agree cognitively with most of what you say.But, if a reader accepted everything you write, he'd be scared to touchanyone intimately without dressing up like a rubber-clad frogman.(Hmmm, now that presents some interesting images... :-)

The challenge, then, is in making this excellent information user-friendlyto the reader, who then is much more likely to incorporate it into his/herdecisions and behavior. Life, sex and relationships included, is notwithout risks -- the key is in(a) learning to manage the risks; and

(b) learning what one is comfortable with and setting behavior limits accordingly.

Appropriate testing is an excellent tool. You touched on communication inrelationships, but one thing you overlooked is communication with one'sphysician -- especially for gay men. The most common reason(s) "not allsites are tested" and "not all STDs are test for" is because(a) the patient was not frank about what he/she had done; and/or

(b) the clinician was ignorant or possibly biased about the stated behavior and its consequences. And unfortunately, given the present political realities in the US, public health clinic resources are so strained that they are NEVER going to do some of the more expensive tests.

Just a couple of errors:1. Yes, there is a test for HPV, even if it isn't "automatically" done; type of HPV is usually included, which is important. (You also list anogenital warts separately -- they are almost always HPV.)

2. At one point, you state that an HIV-ab test is reliable at 3 months; several sections later you say one must wait 6 months. Your first statement was the more correct: by 3 months, accuracy is in the 99% range; like all medical tests, it will never be "perfect".

3. Yes, molluscum can be "tested for", although not in the absence of the symptomatic bumps, from which a sample must be taken. In the absence of symptoms, there's not really a lot of reason to test for it, as it is overwhelmingly (exclusively? -- good research question) transmitted through the bumps. (Since it is a virus, I would expect that some company like Quest or ViroLogic will market an antibody test in time.)

Well, I've blathered on enough. (Feel free to post, with correctattribution, any of the above that's useful.) Thanks for your intelligent,interesting site [ at http://www.seedwiki.com/wiki/not_b4_we_know ] -- keep it up!Sandy

P.S. John James rules! He and Martin Delaney are the most intelligent,informed and insightful writers on HIV in the country!

By John Sandy Bartletthttp://www.gayhealth.com/templates/0/news/index.html?record=1033Even HIV-negative partners in long-term relationships should giveeach other a present by getting tested together to ensure thatthey are both still negative. It is a sad but all too commonphenomena where one partner has sex outside the relationship andbrings HIV back home._______________________________________

With claims, there is no transparency. either one could be lyingfor example.

The strategy of let's get tested together before we have sexfor sexually transmitted infections is not the same as what > ...is called "Negotiated Safety"... it is a > process by which two uninfected men decide together > to not use condoms. > > Negotiated Safety was first described in the > professional literature by Kippax et al in 1993 from > research they conducted among gay men in Sydney, > Australia. > > It is an agreement between two gay men in a > relationship to have a process of getting ready to > stop using condoms when they have anal sex. > > The basis of this agreement is an explicit > understanding that both know each other's HIV status > and are both uninfected.

There's ambiguity when you sayexplicit quote "understanding" unquote.There's not transparency.Which means there's a wink involved when you use the word"understanding" in this context.

Because there's a way for both people to have the same knowledge.

It doesn't mean that the information could be false,but there's no mendacity in it.The test could be false, the doctor could be wrong.But the same tests are used to ensure the safety of the bloodsupply.

The strategy is about passing the informationto the other person.

No objection for people to choose to have sex when one or bothhave an infection.

The problem today is that people have no idea if they areinfected or when they got infected.

The moral equivalent of saying about your blood donation,no don't test that blood, I don't care just give me the blood Ineed, no testing. How many people would take a blood transfusionunder those conditions today? A very small number.

No amount of negotiation will generate concrete knowledge aboutsomebody's status.

How much talk between two people, for example, will give you thesame results as a test? There isn't any amount of talk.

> In order to insure the men go together to be tested > at least three months after either has had any > unprotected sex.

Okay, it's complicated.

Why the three month figure?

For example, with the blood supply they don't wait three monthsafter the test.

They test once when they get the blood.They test immediately.They try to use the blood as soon as possible.Why the three month wait?

> They also go together to get their HIV test results. > > The only time that both partners do not use condoms > is when they have sex with each other, making this an > acceptable safer sex option. > > There must be no unprotected sex outside the > relationship; if either partner does so, then he must > immediately inform his partner prior to their having > sex again. > > They resume using condoms until subsequent HIV tests > prove that the partner who had unprotected sex is > still negative. > > Follow up research has shown that 90% of men in > negotiated safety agreements adhere to them, making > this an effective risk reduction strategy.

Sure just like the strategy, of course it would workprovided you follow it.

The problem is the complexitywith this whole arrangement, this protocol.

> But the 10% who are not compliant with this agreement > are a major source of new HIV infections.

Because you're dependent on interviews how can you possiblycome up with ten percent?...

> One study showed that young gay men in committed > relationships in the Netherlands were becoming > infected at high rates by their partners.

They have created this complex process involving a lot of timeand trouble between two people where the real problem is thecompelling nature of sexuality. When what you need to do isreduce the complexity and the amount of time because sexual urgescompel you to act in spite of all the danger.